Meeting the NSF targets for door-to-needle time in acute myocardial infarction – the role of a bolus thrombolytic

Coronary heart disease (CHD) remains the leading cause of premature death in the United Kingdom. The mortality from myocardial infarction (MI) can be reduced by reperfusion of the infarct-related artery with thrombolytic agents.2,3 The best results for survival are achieved in those patients who are thrombolysed early.4,5 We set out to investigate whether the time between arrival to hospital of a patient with acute MI and administration of thrombolytic therapy (door-to-needle time) could be improved by the introduction of a bolus thrombolytic in the accident and emergency (A&E) department in a busy inner city hospital. This study of 13 months’ duration compared the door-to-needle times and the proportion of patients thrombolysed within 30 minutes before and after the introduction of a bolus thrombolytic agent – reteplase. The findings demonstrated a 37% reduction in door-to-needle time (from 27 minutes to 16 minutes) and a 22% improvement in the proportion of patients thrombolysed within 30 minutes (from 68% to 86%) with reteplase. Our findings suggest that bolus thrombolytic agents such as reteplase can be used in a strategy to meet the National Service Framework (NSF) targets for door-to-needle time.